Vendor Electronic Payment Form

The form below offers vendors the opportunity to receive future payments electronically. 

Vendors wishing to take advantage of this option should follow these steps:

  • Click on one of the links below and save the form to your computer or open it. The acrobat form may open automatically.
  • If you saved the form to your computer, locate the file you just saved and double-click to open it.
  • Complete the form, following the instructions provided.
  • Mail the completed form to the address printed at the top of the form.

The form is available as a Microsoft Word document or as an Adobe Acrobat document.

Please Note: This form is for Vendors only.  State employees should contact their agency Budget Officer.

Vendor Electronic Payment Form: